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COVID-19 and Monkeypox: what are the differences, and are we entering a new pandemic?

Updated: Dec 6, 2022

COVID-19 has impacted the economy, how we interact with each other, food security, education, and life as we once knew it. Just when it seems we’ve gotten a handle on this virus another, monkeypox, surfaces and has sent the healthcare system into a frenzy at the mere thought of another pandemic. Justifiably, people are concerned about the threat of another deadly disease. Here’s what is known, so far, about the similarities and differences between COVID-19 and monkeypox.

Who’s most at risk for COVID-19?

COVID-19 is a contagious disease caused by a virus (SAR-CoV-2). During the earlier phases of the pandemic, it was reported that older adults were the most impacted, and were dying from the disease at higher rates than other groups. While increased age is still a risk factor for getting very sick from COVID-19, other risk factors include having a weakened immune system and having underlying health conditions are at a higher risk also. This includes those with chronic obstructive pulmonary disorder or other chronic lung diseases, chronic kidney or liver disease, diabetes, heart disease, and obesity, among others.

How is COVID-19 spread?

COVID-19 can spread when an infected person breathes out droplets containing the virus. These droplets can be breathed in by others, making contact with one’s eyes, nose, or mouth. In some circumstances, they may also contaminate surfaces they touch. Being in close contact with an infected person for prolonged periods may also increase the risk of infection.

What are the symptoms?

Symptoms of COVID-19 can vary from person to person. Milder cases may present which feel like a cold for some, but others may have more extreme symptoms which require medical attention. Symptoms of COVID-19 may include:

· Fever or chills

· Nausea

· Vomiting

· Diarrhea

· New loss of taste or smell

· Runny nose or congestion

· Fatigue

· Muscle or body aches

· Sore throat

· Cough

You can be free of symptoms and still spread COVID-19.

How to diagnose COVID-19?

If you have symptoms of COVID-19, you should get tested right away. There are two types of tests

· Antigen tests are rapid tests, such as many at-home test kits, and test for the virus. While they’re not as accurate as antibody tests, they are relatively low-cost and easy to administer.

o The current recommendation from the CDC is to take this test twice, 48 hours apart, to best detect infection.

· Antibody tests, such as PCR tests, look for the genetic material of the virus. This test is more reliable than the antigen test, and is most often done in a lab setting, with a turnaround time of 1-3 days, on average. Because this test is quite sensitive to detecting the virus, this test should only be used on people who have not tested positive for COVID-19 within the last 90 days.

Treatment options

If you are positive for COVID-19 and have mild symptoms, CDC guidance is to isolate from others, and monitor for worsening symptoms. You should seek immediate medical attention for the following:

· Trouble breathing

· Pain or pressure in the chest that won’t go away

· Blue lips or fingernails

· New-onset confusion

How long do I need to isolate?

The current guidance by the CDC is to isolate for at least five days, even if you have no symptoms. If you have symptoms, you should isolate for five days, and can end the isolation if you are fever-free for 24 hours without the use of fever-reducing medication. If you had moderate or severe symptoms, like shortness of breath, or had to be hospitalized because of COVID-19 then you should isolate through day 10.

What are the vaccine recommendations?

Consider consulting your provider for COVID-19 vaccine guidance. Medical history and exposure risk can affect guidance recommendations. At the time of this article, the CDC recommends everyone 6 months and older get vaccinated for COVID-19, and everyone five years and older get booster doses.

What is Monkeypox and who’s most at risk?

Monkeypox is a disease that is caused by a virus that causes smallpox. Symptoms are also similar to those of smallpox. Early reports suggested that those most at risk for monkeypox are men who have sex with men; however, more recent data shows that intimate contact with the infection also increases the risk of contracting monkeypox. Similar to COVID-19, those with compromised immune systems are most at risk of becoming severely ill.

How is it spread?

Monkeypox can be transmitted through contact with bodily fluids, lesions, rashes, or scabs on the skin or mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects, such as towels, clothing, and bedding.

What are the symptoms?

Monkeypox presents with fever, an extensive characteristic rash, and usually swollen lymph nodes. There is a febrile stage of illness, which usually lasts 1 to 3 days. Symptoms include:

· Fever

· Headache

· Swelling of the lymph nodes

· Back pain

· Muscle aches

· Lack of energy

The febrile stage is followed by the skin eruption stage, which can last for 2 to 4 weeks. Lesions evolve from macules to papules to vesicles and then to pustules, then to scabs or crusts. It has been reported that these lesions can be painful. According to the World Health Organization, the proportion of patients who die has varied between 0 and 11% in documented cases, with higher rates among young children.

How to diagnose Monkeypox?

PCR tests are the recommended way to test. A sample specimen taken directly from the rash, fluid, or crusts is recommended.

Treatment options

Because of the similarity between smallpox and monkeypox, antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections. Consult with your healthcare provider for the right treatment plan for you.

How long do I need to isolate?

It is recommended to isolate from others until the rash has healed and the skin returns to normal. Like COVID-19, monkeypox can be spread to animals, so isolation from pets is also recommended.

Are we entering a new pandemic wave with Monkeypox?

Populations have become more susceptible to monkeypox likely because of the termination of routine smallpox vaccination, which offered some cross-protection in the past. While the public continues to have conversations about vaccine efficacy, many are worried about whether we are entering a new phase of the pandemic. While it appears monkeypox may not be as severe as COVID-19, new details are emerging daily. More time is necessary to determine which virus causes more upheaval than the other. If COVID-19 taught us anything, it was that we are entering a new normal. Now we must take what we’ve learned from the COVID-19 era and apply it. While we don’t have all the answers, we are better prepared than we were for COVID-19; and that’s progress.


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Liu, G., & Rusling, J. F. (2021). COVID-19 antibody tests and their limitations. ACS sensors, 6(3), 593-612.

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